COMPETENCY CHECKLIST (SAMPLE)
PHN#: Circle Male/Female. Postal Code: Phone #: _____ FACILITY/ AGENCY _____ A. DANGEROUS (Circle Number) Expresses or hallucinates (hears commands) suicidal/homicidal ideas or has made attempt in present illness. Unpredictably impulsive / violent. Expresses suicidal ideation but behaviour is somewhat dependent on the stress in the environment. ... ................
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